Provider Demographics
NPI:1427187012
Name:STACY JEFFRIES
Entity Type:Organization
Organization Name:STACY JEFFRIES
Other - Org Name:JEFFRIES ISL MW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFRIES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-826-8368
Mailing Address - Street 1:2400 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-6514
Mailing Address - Country:US
Mailing Address - Phone:660-826-8368
Mailing Address - Fax:
Practice Address - Street 1:2400 E 10TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-6514
Practice Address - Country:US
Practice Address - Phone:660-826-8368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities